Bringing a mental health focus to nursing regulation

Daniel Allen

Posted 27 November 2018 - 16:23

Nursing leader Claire Johnston reveals her plans to help rebuild the Nursing and Midwifery Council – and her optimism for the future of mental healthcare

Nursing leader Claire Johnston reveals her plans to help rebuild the Nursing and Midwifery Council – and her optimism for the future of mental healthcare

Claire Johnston, who was recently appointed to the board of the Nursing and Midwifery
Council, reveals her plans to help rebuild the regulatory body

‘They’re tough roles,’ says Claire Johnston, describing what it can be like to be a director of nursing in an NHS trust. ‘They have tough challenges and they can be lonely.’

Clearly, though, she thrives on such challenges: she is one of few directors of nursing to clock up more than 20 years in the role, most recently at Camden and Islington NHS Foundation Trust, London, a provider of mental health and learning disability services.

Her career has taken her in many directions. She is a former adviser on primary care and community nursing for the RCN, from where she was seconded to the Department of Health to work on community care reforms.

She holds an honorary professorship at Middlesex University, and is now chair of a charity, KidsTime, which supports the children of parents with mental illness. She is also programme director of CapitalNurse, an organisation that seeks to establish a sustainable nursing workforce for London.

And she has just joined the governing body of the Nursing and Midwifery Council (NMC).

‘There wasn’t one member of staff in that room who didn’t go away feeling differently and more positive about what we can do as a council to respond in the way we need to every time’

The NMC is rebuilding itself following the departure in May of chief executive Jackie Smith, who resigned just before publication of a review of how the regulatory body handled concerns about midwives at Furness General Hospital, part of University Hospitals of Morecambe Bay NHS Trust, where 11 babies and one mother died. The NMC was criticised for its ‘frequently incompetent’ handling of some of the cases.

No nurse could fail to be moved by what unfolded there, says Ms Johnston. And her decision to seek appointment to the NMC’s ruling council was in part driven by a desire to construct something positive from those tragic events.

‘Clear challenges’

‘One could feel and see that regulation, and our regulator perhaps in particular, was facing some clear challenges and I felt I could make a contribution in a positive way,’ she says.

She describes a recent engagement event for NMC staff attended by one of the bereaved mothers. ‘There wasn’t one member of staff in that room who didn’t go away feeling differently and more positive about what we can do as a council to respond in the way we need to every time,’ Ms Johnston says.

‘One could feel and see that regulation, and our regulator perhaps in particular, was facing some clear challenges and I felt that I could make a contribution in a positive way’

The NMC governing council sets strategic direction and holds the executive team, including interim chief executive Sue Killen, to account. It comprises 12 members, half of whom are, like Ms Johnston, registrants. They are appointed by the privy council following a recruitment process, which Ms Johnston describes as ‘rightly rigorous’.

With her long experience at Camden and Islington, Ms Johnston brings a perspective to the regulator that has been shaped by many years working in mental health. But she is not a mental health nurse. She trained in general nursing and then worked in community settings but argues that, in the upper echelons of governance structures, direct experience in a particular field of care is less important than management skills and experience.

‘At a leadership level, it’s irrelevant,’ she says of the fact that she never trained in mental health. ‘I would consider myself pretty expert on matters mental health and it’s not been any kind of disadvantage.’ She adds that one of those she mentored at Camden and Islington trust became the first mental health nurse to be appointed director of nursing in an acute trust.

‘We had a big focus on research and development, which was a huge and positive success for our nurses’

Ms Johnston is proud of what she helped to achieve at Camden and Islington.

‘We were early adopters of a lot of programmes including, for example, new roles, a mental health graduate scheme for direct entrants, which was really a forerunner of what we now know as nursing associates. And we had a big focus on research and development, which was a huge and positive success for our nurses.’

She also worked hard to ameliorate what she calls the ‘scandalous situation’ of those with serious mental illness dying younger than the general population.

Ms Johnston says her appointment to the NMC council reflects an acknowledgement by its chair, Philip Graf, who took on the role in May, that more expertise in mental health and community nursing was required.

‘Council has recognised the need to focus on those areas,’ she says. ‘Of course, that doesn’t mean as a registrant member of council I’m not taking a full corporate view, but there was a recognition of the growing importance of mental health in the wider social context.’ An understanding of mental health issues is ‘absolutely critical’ for all 650,000 NMC registrants, she adds.

Even before events at Morecambe Bay, perceptions of the NMC had not always been favourable, especially among those it regulated. With regard to its disciplinary function, for example, research on behalf of the NMC published earlier in the year found that stakeholders – nurses, employers and the public – felt fitness to practise processes were ‘long-winded’ and ‘time consuming’.

Stretched to the limit

But the NMC is reforming these processes and has pledged to take into account the ‘daily pressures and challenges’ that nurses face. As a former head of nursing in an inner-city mental health trust, Ms Johnston understands such challenges well.

‘The pressures on mental health are extraordinary,’ she says. ‘And we see that, sadly, with people who are not able to perform, not because they’re bad nurses – far from it, they’re wonderful nurses – but because they’re stretched to the limit.’

That said, she is optimistic about the future of mental healthcare as a nursing specialty. ‘I think mental health nursing is becoming far more confident than it’s ever been.’

Reasons for her optimism include more empathetic media coverage and high-profile campaigners, including princes William and Harry, who are willing to discuss their own mental health. ‘It’s okay not just to talk about mental health, but to gain an understanding of what it means to be mentally ill,’ says Ms Johnston.

The NMC’s new standards for education will result in greater understanding among all nurses and midwives of mental health conditions, she adds, irrespective of the specialty in which they practise.

‘And if they have that understanding – not as much, obviously, as someone who has studied mental health nursing at graduate level – that’s going to be transformative.’

Tips for beginners

As a nurse with long experience, Claire Johnston offers this advice to those starting out on their mental health nursing careers:

Embrace the team. You will spend more time with your team than with your partner, so value team members’ contribution. ‘Having that opportunity to unload, share and reflect is absolutely critical, especially for new graduates’

Know your sphere of influence. ‘In the early part of your career you can expend a lot of emotional energy on things you can’t change, and that can leave you frustrated’

Learn from bad managers, as well as the good ones. ‘If you find yourself in a situation with a manager you find difficult and whose behaviour and values you don’t share: well, you’re not going to stay forever in that environment, but you can learn a lot from a poor manager and it can stand you in good stead’